Contributed by
Vanderbilt University Medical Center
Emma Neal, MD PhD, and Jessica Leschied, MD.
History
18-year-old girl presents with left shoulder pain after a fall at wrestling practice and reports feeling a “popping” sensation followed by pain.
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Question
Which fracture type is present in this patient?
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Correct answer
Salter-Harris I
Discussion
This patient was treated conservatively for an AC joint separation at the time of initial presentation. Persistent pain and limited range of motion prompted further evaluation with an MRI of the left shoulder. The MRI demonstrated a distal clavicular periosteal sleeve fracture with posterior displacement of the distal clavicle relative to the periosteum. The periosteum remained attached to the acromion. Both the acromioclavicular and coracoclavicular ligaments remained intact, and no labral pathology was visualized.
Periosteal sleeve fractures are Salter-Harris I fractures through the distal clavicular physis. The distal clavicular metaphysis protrudes through a tear in the clavicular periosteum while the epiphysis remains aligned with the acromion. Acromioclavicular and coracoclavicular ligaments remain intact. Diagnosis may be confounded by the small size of clavicular epiphyses and relatively delayed epiphyseal ossification and fusion. Injures are classified by the Dameron and Rockwood classification. Outcomes are generally excellent for nondisplaced or minimally displaced fractures.
Additional images
References
- Kim WG, Laor T, Jarrett DY. Physeal injuries of the clavicle: pediatric counterparts to adult acromioclavicular and sternoclavicular joint separations. Pediatr Radiol. 2023 Jul;53(8):1513–25.
- Lomasney LM, Lim-Dunham JE, Cappello T, Annes J. Imaging of the pediatric athlete: use and overuse. Radiol Clin North Am. 2013 Mar;51(2):215–26.
- Delgado J, Jaramillo D, Chauvin NA. Imaging the Injured Pediatric Athlete: Upper Extremity. Radiographics. 2016 Oct;36(6):1672–87.